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Variations in Endothelial Function and Arterial Compliance during the Menstrual Cycle

Baker Medical Research Institute, St. Kilda Central, Melbourne, Victoria 8008, Australia; Alfred Hospital (J.P., P.A.B.), Prahran, Melbourne, Victoria 3181, Australia; and International Diabetes Institute (R.A.W.), Caulfield South, Melbourne Victoria 3162, Australia

Address all correspondence and requests for reprints to: Prof. Paul Komesaroff, Baker Medical Research Institute, P.O. Box 6492, St. Kilda Central, Melbourne, Victoria 8008, Australia. E-mail: paul.komesaroff{at}baker.edu.au

Abstract

Female sex hormones have been implicated in the cardioprotection of premenopausal women. However, the cardiovascular actions of these hormones and the effects of their natural fluctuations during the menstrual cycle are not fully understood. We studied changes in vascular function during the menstrual cycle in 15 healthy premenopausal women. Four noninvasive procedures were performed during the early follicular (EF), late follicular (LF), early luteal (EL), and late luteal (LL) phases: flow-mediated dilatation (FMD) of the brachial artery during reactive hyperemia, laser Doppler velocimetry (LDV) with direct current iontophoresis of acetylcholine (ACh) and nitroprusside, whole body arterial compliance (WBAC), and pulse wave velocity. Hormone levels were consistent with predicted cycle phase and showed that all subjects ovulated during the cycle studied. FMD, LDV with ACh, and WBAC varied cyclically, with significant increases from the F to LF phase, sharp falls in the EL phase, and significant recoveries in the LL phase. These changes were most marked for FMD [EF, 8.8 ± 0.6% (mean ± SEM); LF, 10.0 ± 0.7; EL, 4.2 ± 0.6; LL, 8.6 ± 0.9] and the LDV response to ACh (EF, 2.7 ± 0.2 V/min; LF, 3.3 ± 0.4; EL, 1.8 ± 0.3; LL, 2.7 ± 0.4). WBAC changed similarly (EF, 0.58 ± 0.08 arbitrary units; LF, 0.84 ± 0.06; EL, 0.65 ± 0.05; LL, 0.68 ± 0.06). Sodium nitroprusside-induced vasodilatation decreased significantly from EF to EL, with no other significant difference, and pulse wave velocity did not vary significantly over the four time points.

Conductance and resistance artery endothelial reactivity and smooth muscle sensitivity to nitric oxide and arterial compliance are modulated significantly in response to the changing hormonal patterns of the menstrual cycle. These findings emphasize the importance of menstrual phase in the interpretation of data on endothelial function and may provide insights into the mechanisms underlying sex differences in cardiovascular risk and other disease processes in premenopausal women.

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